My sister had infertility for over 10 years.  I went with her through the anguish in her and our entire family, and understood from her point of view as well as my parents’ view, who could not become grandparents, the anguish of not being able to conceive of a child.  These were the early days before IVF.  When I came out of my army service, it was 1981.  Louise Brown was the first IVF baby born in 1978.  That was followed by a long hiatus and finally in 1981, the same year that I finished my army service as a physician, the first IVF baby, Elizabeth Carr, was born in the United States.  From afar, back in Israel, I followed with great anticipation the development of in vitro fertilization, which at the beginning of the 1980s was considered to be a scientific miracle.  It was only three years later that I decided to make a change in my career and leave a surgical residency in Israel in favor of an OB/Gyn residency in the United States aiming to become a subspecialist in infertility.  I realized that IVF was not a random occurrence, but was rapidly becoming a reproducible and reliable method of helping women become pregnant, who would have otherwise remained childless.  I decided at that point that I had to be a part of this amazing field and have never regretted it since.

A specific patient comes to mind.  Relatively early in my career as a reproductive endocrinologist, I came to treat a patient who was born without a vagina.  I helped create a vagina for her by using her own skin graft.  Over ten years later, the patient came back, desirous of having a child.  Since she did not have a uterus but had ovaries, I was able to retrieve eggs from her ovaries and, with her husband’s sperm, create embryos that were then transferred to her sister, and she conceived of a child.  That closed an amazing circle for me as well as for my patient.   

As you probably know, I am very enthusiastic about this job.  I have lots of favorites.  I just absolutely love being a fertility specialist.  My favorite part is the people, I love people.  Doing this gives me a chance to touch so many people’s lives, it’s a blessing.

Compassion

Never give up.  There are always options for you to have children. The sky is the limit.  Find a fertility specialist that you trust, and stick with her or him until you have a baby.

There is a saying in Judaism that prophecy was given to the fools. But if I dare project, I think that we are heading in several directions.  A) We, on the genetic frontier, are going to be able to screen embryos for more and more diseases, as well as chromosomal abnormalities, and produce healthier babies.  B) Multiple researchers are now working on reproductive aging.  Without getting into specifics, we might in the future be able to use the patient’s DNA, even when she gets older, to create children.   C) We will continue to reduce multiple pregnancy rates.  As the efficiency of in vitro fertilization goes up, we will be doing more and more single embryo transfers and not only reduce the triplet rate but also the twin rate.  D)  We will do more unstimulated cycles as in vitro maturation of eggs continues to develop.  E) Egg freezing will provide women with long-sought reproductive freedom.

Practically everything.  When I was a fellow, vaginal ultrasound was introduced and it changed the way we do IVF from a cumbersome laparoscopic procedure that took over an hour with general anesthesia, to transvaginal aspiration that takes a few minutes and is done under IV sedation.  While the first decade of IVF in the 80’s and into the beginning of the 90’s was what I call the decade of the female, males still faired poorly, and if there was little sperm or no sperm, donor sperm was usually used.  The invention of ICSI in the 90’s, first in Europe, and then in the mid-90’s finally in the United States, created a revolution in the treatment of the infertile male, making even males with very little sperm or obstruction of their system, capable of fathering genetic children.  With pre-implantation genetic diagnosis, the ability to pluck out a single cell from an embryo and make a genetic diagnosis on embryonic health, has been an amazing development, comitant with so many advances in genetics itself.  We are in the midst of the genetic revolution, and getting a handle over people’s genetic misfortune and being able to reverse it. 

My main motto is “love your patient”.   In addition, I have learned that things are constantly changing, and what is almost an axiom today, can be proven wrong and outdated very soon.  So you have to exercise humility and you have to listen to your patients because they are the key to your success.

I think that we have still not gotten through to women that reproductive aging plays such a major role.  Women still don’t understand that there is a rapid decline of the number of eggs available to them before they reach the middle of their life.  They also don’t understand that most of the eggs in a woman who is approaching 40 are abnormal genetically and, therefore, her chances to conceive are lower and the chances of a miscarriage are higher.  However, we have plenty of pregnancies at 40 and beyond and women should not give up because of that information, just hurry up and seek aggressive fertility treatment.

A patient up to 35 years of age should probably seek treatment by a fertility specialist after one year of trying to conceive.  At over 35, I think that even 6 months of trying is enough time to see a fertility doctor.  The patient should indicate to her gynecologist that she would prefer not to be treated for fertility in the general ob/gyn office, but rather be referred immediately. 

Our center currently has five physicians, all of whom are board certified in reproductive endocrinology and all of whom have been trained in Ivy League institutions.  A sixth physician that we are adding this summer is a young woman coming straight out of fellowship at the University of Pennsylvania, thus continuing this tradition.  The Center is extremely well-organized.  All the notes are typed and easily retrievable from the patient’s records.  Our staff is trained to be courteous and sensitive to the patients.  The Center is extremely organized due to a strong professional leadership and business leadership.  Patients are provided with written material, both hard copies and online, practically on every treatment they are being offered.

The Health System now encompasses 14 hospitals with several more major affiliations with other hospitals. The system has some of the best doctors in New York.  Therefore, once you are a patient within our system, you have a network of highly qualified physicians who have had excellent training practically in all medical, surgical, and pediatric fields.

I find all areas of fertility treatment fascinating.  My interest in in vitro fertilization is both from the clinical as well as the laboratory point of view, as I am in charge of the Andrology and IVF lab.  I am extremely interested in pre-implantation genetic diagnosis (PGD), a program that I started several years ago, which is growing by leaps and bounds.  I also run the Donor Egg Program, and consider it a blessing that I can offer patients who struggle with reproductive aging, to extend their fertility and create families for them.

Yes, plenty.  But the first one is be kind to yourself.  Don’t be hard on yourself.  Don’t blame yourself for starting too late; for getting an abortion when you were young and not ready for motherhood; don’t blame each other, husband blaming wife and wife blaming husband.  Typically infertility is not solely “his fault” or “her fault,” it takes two to tango.  Don’t stress yourselves over the right days to have sex.  It will strain your marital relationship and kill your sex life.  Instead, trust your fertility doctor that the fertility procedures such as inseminations or embryo transfers will be done at the appropriate time at the center.  Once again, sex can become a recreation rather than just a vehicle for procreation.  Don’t give up.  I know this is tough.  As I said before, the sky is the limit. There is no situation where ultimately you cannot end up having a baby, even if there are no eggs or even if there is no sperm, with an open mind, we can help you have a family.

Yes, I do.  Patients come in all the time to show me their babies.  Sometimes they continue their contact for years and send pictures, Christmas cards with their babies’ pictures, or come for repeat visits.  Occasionally, I get to see babies that I have helped create grow up and have met several of them as young teenagers. It is amazing to see a whole human being that you had seen before as a small embryo.

If you are the spouse of an infertility patient, you are an infertility patient as well.  We have the best results when a couple acts in unison and is supportive of each other.  It takes two to tango.  It is not his fault or her fault.  You will be the happiest family if you have worked on it together.  Your spouse needs you. The more you can be supportive of her by showing up for appointments, by showing your presence, by being patient with her moods when she gets hormone shots, or when she hears certain news from us, the better the results in the future.

Spare time, huh?  Well, I try to make my spare time.  I am an avid reader and I write creatively.  I am enticed with stories that have to do with our field and have just published a reproductive thriller.

Music, I love music of all sorts, but especially classical.  I used to play the violin. I go to many concerts and to operas, but I love the entire scope of music from very classic to current pop and rock. 

I love to travel and to explore new countries and new people. I like everything with the performing arts, including plays and movies. I exercise avidly, but I still don’t understand the rules of football or baseball.